Provider Demographics
NPI:1881119998
Name:SCOTT-LARSON, KRISTEN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SCOTT-LARSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-3238
Mailing Address - Country:US
Mailing Address - Phone:814-539-7339
Mailing Address - Fax:
Practice Address - Street 1:188 GILBERT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-3238
Practice Address - Country:US
Practice Address - Phone:814-539-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional